Huntsbriar Care Group Application Form
Fill out the form carefully for your job application.
APPLICATION FORM
Position Applied for
*
Please Select
NURSE
CARER
Management
Part-Time/Full-Time Options
*
Please Selecti
Full Time
Part Time
Days
Nights
Do you require?
*
Please Select
Days
Nights
Number of Hours wanted?
*
PIN NUMBER:(Nurses Only)
Issue Date: (Nurses Only)
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Month
-
Day
Year
Date
Available Start Date:
*
-
Month
-
Day
Year
Date
Desired Salary:
*
PERSONAL INFORMATION
Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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5
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30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
Prefer not to say
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date started living at this address:
*
-
Month
-
Day
Year
Please provide 5 years address history, there is a section at the end of the application form for you to do this.
Please give details of any changes of address in the box below including DATES & postcode.We require 5 years of address history to process employment.
*
E-mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
NI Number:
*
Format: (000) 000-0000.
DBS Number:
*
Format: (000) 000-0000.
DBS Number Issue Date:
*
-
Month
-
Day
Year
Date
Do you require a VISA to work?
*
Please Select
Yes
No
Expiry date & Restrictions:
*
Own Transport? (Car, Motorbike)
*
Please Select
Yes
No
Driving License
*
Please Select
Yes
No
Endorsement:
*
EMERGENCY CONTACTS
Relationship:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EDUCATION
Name of University
Qualifications
Start Date
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Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Name of College
Qualifications
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Name of School
Qualifications
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Courses attended
Pass/fail & Date Awarded
Provider
EMPLOYMENT HISTORY
Employer 1
PLEASE PROVIDE FULL HISTORY
Name & Address
*
Employment Start Date
*
-
Month
-
Day
Year
Date
Employment End Date
*
-
Month
-
Day
Year
Date
Position Held
*
Salary
Please include hourly rates.
Reason for leaving
*
Employer 2
PLEASE PROVIDE FULL HISTORY
Name & address
*
Employment Start Date
*
-
Month
-
Day
Year
Date
Employment End Date
*
-
Month
-
Day
Year
Date
Position Held
*
Salary
Please provide hourly rates.
Reason for leaving
*
Employer 3
PLEASE PROVIDE FULL HISTORY
Name & Address
*
Employment Start Date
*
-
Month
-
Day
Year
Date
Employment End Date
*
-
Month
-
Day
Year
Date
Position Held
*
Salary
Please provide hourly rates.
Reason for leaving
*
Please provide any gaps in employment that you have had in the box below including a reason for the gap ie. Pregnancy, leave of absence, holiday etc.
PLEASE INCLUDE: POSITION, EMPLOYMENT PERIOD, SALARY, REASON FOR LEAVING.
REFERENCES
Reference 1
Please provide one from your most recent employment
Name
*
First Name
Last Name
Position
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Notes
Additional References & Details
APPLICATION QUESTIONS
Why do you want to work at this company? (200 words)
*
Briefly outline your skills and experience that makes you good fit for this role: (200 words)
*
What is your biggest professional achievement so far? (200 words)
*
ASSISTANCE WITH INTERVIEW AND ASSESSMENT
Do you require us to make any special arrangements in order for you to participate in the recruitment process?For example, large print forms? Or additional time to complete forms?
*
Yes
No
If yes, please give details:
*
GP Name
*
Any offer of employment may be made subject a satisfactory medical report.
GP Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
GP Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CRIMINAL HISTORY & CONSENT
Workers of Huntsbriar Care Group Limited will be subject to a police check called DBS Certificate. Please declare all convictions, spent or unspent, charges, whether proceeded with or not, warning and cautions you have received in the box below.Please be aware that you will also have to pay for this check as part of the application process.
*
I consent to the processing of my personal informations for the purpose explained to me and information will not be shared or passed on to third party
*
I Agree and Submit
I Disagree
I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment.I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.I understand that I cannot be offered a post, until a satisfactory response has been received with respect to my DBS register status, and that should I subsequently be offered a post, that offer will be subject to receipt of TWO satisfactory references, ONE of which should be from my previous employer.I understand that until a satisfactory response has been received from DBS, and my employment confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people.If the post I have applied for is as a registered Nurse, my confirmation of employment will also be subject to a satisfactory search of Nurses and Midwifery Council records and registers.By my signature, I authorise the organisation to request a DBS register check from the DBS, on initial employment and at any time during my employment thereafter.I understand to inform my employer immediately if my DBS register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction referral to any register of barred care workers, or withdrawal of any registration required by my employment status.
*
I Agree
Submit Application
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